Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Ang, Lawrence; Behnamfar, Omid; Palakodeti, Samhita; Lin, Felice; Pourdjabbar, Ali; Patel, Mitul; Reeves, Ryan; Mahmud, Ehtisham

doi:10.1161/jaha.117.006580

Cited by 37 publications

(47 citation statements)

References 25 publications

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“…Fibrinogen (Fib), as a thromboplastic and inflammatory marker, facilitates blood viscosity, platelet aggregation, fibrin cross-linking, and plays a pivotal role in the progression of atherosclerosis [1,2]. Previous studies showed that Fib was not only an indicator of subclinical cardiovascular diseases, such as coronary artery calcification and intima-media thickness of the carotid artery [3,4], but was also independently associated with the development of coronary artery disease (CAD), hypertension, stroke, as well as adverse cardiovascular events [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease

Liu

Shi

et al. 2020

Cardiovasc Diabetol

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Background: The present cohort study aims to examine the relationship between fibrinogen (Fib) levels and glucose metabolism [fasting blood glucose (FBG) and hemoglobin A1c (HbA1c)] and investigate the impact of high Fib on cardiovascular outcomes in patients with stable CAD and pre-diabetes mellitus (pre-DM) or diabetes mellitus (DM). Methods:This study included 5237 patients from March 2011 to December 2015. Patients were distributed into three groups according to Fib levels (low Fib, median Fib, high Fib) and further categorized by glucose metabolism status [normal glucose regulation (NGR), Pre-DM, DM]. All patients were followed up for the occurrences of major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal MI, stroke, and unplanned coronary revascularization.Results: Linear regression analyses showed that FBG and HbA1c levels were positively associated with Fib in overall CAD participants, either with or without DM (all P < 0.001). During an average of 18,820 patient-years of follow-up, 476 MACEs occurred. High Fib was independently associated with MACEs after adjusting for confounding factors [Hazard Ratio (HR): 1.57, 95% confidence interval (CI) 1.26-1.97, P < 0.001]. Furthermore, DM but not pre-DM was a significant predictor of MACEs (P < 0.001 and P > 0.05, respectively). When patients were stratified by both glucose metabolism status and Fib levels, high Fib was associated with a higher risk of MACEs in pre-DM (HR 1.66, 95% CI 1.02-2.71, P < 0.05). Medium and high Fib levels were associated with an even higher risk of MACEs in DM (HR 1.86, 95% CI 1.14-3.05 and HR 2.28, 95% CI 1.42-3.66, all P < 0.05). After adding the combination of Fib and glucose status to the Cox model, the C-statistic was increased by 0.015 (0.001-0.026). Conclusions:The present study suggested that Fib levels were associated with FBG and HbA1c in stable CAD patients. Moreover, elevated Fib was independently associated with MACEs in CAD patients, especially among those with pre-DM and DM, suggesting that Fib may provide incremental value in the cardiovascular risk stratification of pre-DM and DM patients.

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Section: Introductionmentioning

confidence: 99%

Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease

Liu

Shi

et al. 2020

Cardiovasc Diabetol

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“…10,11 Previous studies have shown that fibrinogen was not only independently associated with the development of CAD, hypertension and stroke, but also an independent predictor of long-term prognosis in patients after PCI. [12][13][14] More recently, it has been reported that the D-dimer to fibrinogen ratio (DFR) is a novel predictor for the outcomes of pulmonary thromboembolism (PTE), ischemic stroke and gastrointestinal stromal tumors (GISTs). [15][16][17] However, the relationship between the DFR and prognosis in CAD patients after PCI has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

D-Dimer to Fibrinogen Ratio as a Novel Prognostic Marker in Patients After Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

Zheng

Tang

Yang

et al. 2020

Clin Appl Thromb Hemost

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The role of activation of the coagulation and fibrinolysis system in the pathogenesis and prognosis of cardiovascular diseases (CVDs) has drawn wide attention. Recently, the D-dimer to fibrinogen ratio (DFR) is considered as a useful biomarker for the diagnosis and prognosis of ischemic stroke and pulmonary embolism. However, few studies have explored the relationship between DFR and cardiovascular disease. In our study, patients were divided into 2 groups according to DFR value: the lower group (DFR < 0.52, n = 2123) and the higher group (DFR ≥ 0.52, n = 1073). The primary outcome was all-cause mortality (ACM) and cardiac mortality (CM). The average follow-up time was 37.59 ± 22.24 months. We found that there were significant differences between the 2 groups in term of ACM (2.4% vs 6.6%, P < 0.001) and CM (1.5% vs 4.0%, P < 0.001). Kaplan–Meier analyses showed that elevated DFR had higher incidences of ACM (log rank P < 0.001) and CM (log rank P < 0.001). Multivariate Cox regression analyses showed that DFR was an independent predictor of ACM (HR = 1.743, 95%CI: 1.187-2.559 P = 0.005) and CM (HR = 1.695, 95%CI: 1.033-2.781 P = 0.037). This study indicates that DFR is an independent and novel predictor of long-term ACM and CM in post-PCI patients with CAD.

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“…Unlike apolipoprotein B, apo(a) does not contain lipid domains or transport lipid, but instead, it potentiates atherothrombosis through additional pathways including proin ammatory, and potentially anti brinolytic effects by inhibiting plasminogen activation [10]. As one of the important components of brinolytic system, plasma brinogen (Fib) has been proved to be a pivotal CVD risk factor [11][12][13]. However, little is known about the inter-relationship of Lp(a) and Fib in the CVEs risk prediction in the secondary prevention setting.…”

Section: Introductionmentioning

confidence: 99%

Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study

Zhang¹,

Jin²,

Cao³

et al. 2020

Preprint

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Background: Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes. Methods: In this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan-Meier, Cox regression and C-statistic analyses were performed.Results: During a median of 37.1 months’ follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5% vs. 5.3% vs. 5.6%, p=0.001) and Fib (4.0% vs. 4.4% vs. 6.1%, p<0.001) categories. When further classified into 9 groups by Lp(a) and Fib levels, the CVEs were highest in the 9th (Lp(a)-High and Fib-High) compared with the 1st (Lp(a)-Low and Fib-Low) group (7.2% vs. 3.3%, p<0.001). The highest risk of subsequent CVEs was found in the 9th group (HRadjusted 2.656, 95% CI 1.628-4.333, p<0.001), which was more significant than Lp(a)-High (HRadjusted 1.786, 95% CI 1.315-2.426, p<0.001) or Fib-High (HRadjusted 1.558, 95% CI 1.162-2.089, p=0.003) group. Moreover, adding the combined Lp(a) and Fib increased the C-statistic by 0.013.Conclusion: Combining Fib and Lp(a) enhance the prognostic value for incident CVEs beyond Lp(a) or Fib alone.

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Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Cited by 37 publications

References 25 publications

Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease

Fibrinogen is associated with glucose metabolism and cardiovascular outcomes in patients with coronary artery disease

D-Dimer to Fibrinogen Ratio as a Novel Prognostic Marker in Patients After Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study

Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study

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